Successful breastfeeding begins with education!

1. Breastfeeding Success Course Successful breastfeeding begins with education! Randy Heninger LT, NC, USNR Lactation Specialist U.S. Naval Hospital Keflavik

2. A Joke to Start Us Off A student sat in his Life-Science classroom, staring at his final exam, paper. One question stymied him: “Give four advantages of breast milk.” His first three examples: 1. No need to boil. 2. Never goes sour. 3. Available whenever necessary. But, what fourth example to give?? Suddenly it dawned on him. 4. Available in attractive containers of varying sizes. He received an A.

3. Breastfeeding through time "Virgin of the Green Cushion" Solario "Motherhood"Angelina and the child DiegoDiego Rivera

4. Milk Production Cells - Mature at Birth of Newborn Duct - Carry milk to Sinuses Sinuses - hold milk until breast is suckled or pumped Nipple openings - 5 to 10 Anatomy

5. Anatomy (cont.) • Supernumerary nipple line

6. Latch • Initial in delivery positively impacts the long-term success of mother and infant. • Obstacles • Heavily medicated mother • Narcotics • Cesarean section • Magnesium therapy (pre-eclampsia) • Infant with a 5-minute Apgar score under 6 • Premature infant less than 36 weeks gestation

7. Latch • C/Section • Timing of the milk coming in or concentration of major milk constituents does not change with type of delivery. • Most nurse within one hour postoperatively some even in the recovery room. • Involution of uterus • Less bleeding • Vaginal • Within one hour of delivery of placenta • Oxytocin (pitocin) levels are at their highest • Involution of uterus • Less bleeding

8. Latch • Stimulating milk-ejection reflex (let down) • Nipple stimulation • Roll nipple between fingers (erect shape) • Lightly stroke breast from outer to inner • Message from outer to inner

9. Latch • Position • Cradle hold • Rest baby on a pillow, his head in the crook of your elbow. Using the C hold (four fingers under your breast, thumb on top), support your breast with your other hand.

10. Latch • Position (cont.) • Cross-cradle hold • This is the cradle hold with hands reversed. If you have baby in a right-handed cradle hold, for example, switch hands: Your right hand will be holding your breast, while baby's head rests in your left hand, your forearm along his back.

11. Latch • Position (cont.) • Football hold • Sit comfortably, with your back well supported, a pillow at your side and partially covering your stomach. Rest baby on the pillow, his bottom near your elbow and his back against your forearm. Use one hand to hold his head and the other to support your breast with the C hold.

12. Latch • Position (cont.) • Side-Lying Position • The lying down position is basically the same as the cradle hold, but with baby and mother lying on their sides facing each other. • Place two pillows under your head, a pillow behind your back, a pillow under your top leg, and a fifth pillow tucked behind your baby. Five pillows sounds like a lot, but remember a golden rule of nursing: if mother is comfortable, baby is likely to be more comfortable, too. • Place your baby on her side facing you, and nestled in your arm. Slide baby up or down along the mattress to get her mouth lined up with your nipple.

13. Latch • Position (cont.) • Mom’s position • How you sit, how you hold your baby, and how you offer your breast all affect how the baby latches on. These facts determine how comfortable you will be during breastfeeding. • Place one or more pillows behind your lower back, and/or shoulders so that you are comfortable and relaxed. • You'll need at least one pillow in your lap to bring baby up to the level of your breast, and another under the arm that will support your baby as he breastfeeds. • If you are sitting in a chair, use a foot stool or something else to raise your lap so you don't have to strain or lean over to get baby closer to your breast. • If you're in bed, put pillows under your knees.

14. Latch • Latch • Opening wide • Use your nipple to tickle baby's lower lip to encourage her to open her mouth wide--really wide. • As the mouth opens to its widest point, direct your nipple into the center and use your arm behind to pull baby in very close to you. Don't lean forward, pushing your breast toward your baby; pull her close to your breast by moving your arm

15. Latch • How to Get Baby to Open Wide • Talk to your baby and say "Open." Show her what to do by opening your own mouth wide. Babies can imitate adult facial expressions. • Help your baby open her mouth wider by using the index finger of the hand supporting your breast to press firmly down on your baby's chin as you pull her on. You will probably need someone else to do this for you at first.

16. Latch • Correct latch • Baby's top and bottom lip should be turned out (everted). When baby takes the breast with mouth open wide, he'll have a "fish mouth" look as he nurses. • Baby's chin should be pressed into the breast with his nose resting on the breast, as well. You will notice that baby is able to breathe out the sides of his nose, even when pressed against your breast. Babies are designed that way. If your baby struggles, pull baby's bottom closer to you.

17. Latch • Wrong latch-on. • Baby's lower lip should not be pursed inward, but should be turned outward. • However • Great alertness and eye contact.

18. Latch

19. Latch • Suckling • To take in nourishment at the breast and specifically refers to breastfeeding. • Learned higher brain function vs. sucking which is a automatic reflex tested for at birth. • Coordination of suck and swallow • Develops during second trimester (swallowing of amniotic fluid). • Infants swallow once every 2-3 sucks. By four days of life once with every suck. • Obstacles that influence sucking • Narcotics during labor significantly lower rates and pressures compared to those whose mothers received no medication. • Some studies show that Epidural anesthesia effect feeding abilities of neonates.

20. Latch • How do I know when my baby is done feeding? • First part of feed, tight fist grip • Vigorous suckle

21. Latch • How do I know when my baby is done feeding? (cont.) • Second part suckle is less vigorous and there are frequent pauses • Hand begins to open

22. Latch • How do I know when my baby is done feeding? (cont.) • Final stage need more be said?

23. Latch • How do I know if my baby is getting enough? • 4-8 stools per day • Meconium birth-3 days • Dark green to black thick appearance • 6-8 wet diapers per day

24. Latch • How do I know if my baby is getting enough? (cont.) • Breastfeed stool from 2 - 4 day of life on in a term baby. • Seedy mustard appearance

25. Latch • How do I know if my baby is getting enough? (cont.) • Swallowing during suckling • Weight gain!!!

26. Supply and Activities of Daily Living • Composition • Colostrum, transitional and mature milk contains: • Proteins • Carbohydrates • Fats • Water • Antibodies

27. Supply and Activities of Daily Living • Three stages of milk development: • 1 Colostrum • Provides a boost of antibodies • Laxative effect that expels meconium • Establishes lactobacillus bifidus as predominate bacteria in the sterile newborn gut. • Lasts up to day four postpartum. • 1-123cc first 24 hours then 500cc/day by day 5.

28. Supply and Activities of Daily Living • Three stages of milk development (cont.): • 2 Transitional milk • Up to day 10 postpartum • 500cc/day

29. Supply and Activities of Daily Living • Three stages of milk development (cont.): • 3 Mature milk • Starts by day 10-14 • 750cc by 3 month (singleton birth) • Can vary between 200cc/day in partial breastfeeding to 3500cc/day in wet nurses.

30. Supply and Activities of Daily Living • Pumps • Added stimulation at birth • Poor latch due to meds and epidurals etc. • Infant transferred to Reykjavik for treatment or monitoring. • Medela Classic is used inpatient postpartum

31. Supply and Activities of Daily Living • Pumps • Increase milk supply and milk storage • Work • Sitters • Vacations • Fathers to feed in the middle of the night • Many others • Rental from hospital is the Lactina Select (30 days) • Used until personal pump arrives

32. Supply and Activities of Daily Living • Pumps • Recommended personal pumps • Ameda Purely Yours • 160.00 to 199.00 • http://www.babybungalow.com/ampuryourbre.htm

33. Supply and Activities of Daily Living • Pumps • Recommended personal pumps • Medela Pump in Style Professional • $189.00 as shown • $199.00 w/car adapter • Problems with milk getting into pump. • http://www.babyproductsrus.com/html/pumpinstyle2001.html

34. Supply and Activities of Daily Living • Pumps • Recommended personal pumps • 43.95 includes, Stand Travel Cover, Sealing Disc, Newborn Nipple, Spare Diaphragm, 2 Valves • Good control • Sold at exchange and Viking mall • http://www.babyproductsrus.com/html/avent.html

35. Supply and Activities of Daily Living • Supplemental Feeds • First an attempt to place the infant to the breast is attempted for about 10-15 minutes before each supplemental feed! • Then supplement 10-15cc of breast milk or formula to last infant about 2 hours.

36. Supply and Activities of Daily Living • Supplemental Feeds • Usually are only needed during first few days of life to one week of age. • Cup (easy inexpensive, fast, requires baby to place mouth as they would for breastfeeding.

37. Supply and Activities of Daily Living • Supplemental Feeds • Finger feeds • Great for fathers to do! • Positioning is more of that an infant breastfeeding. • Quick and amount is given is easily controlled.

38. Supply and Activities of Daily Living • Supplemental Feeds • Supplemental Nursers • Closest thing to breastfeeding plus nipple stimulation • Reinforces bad latching. • Difficult to use without help

39. Supply and Activities of Daily Living • Supplemental Feeds • Each supplemental feed is followed by 15-20 minutes of pumping. • Remember to bring in mature milk at 10 days of life, the breasts must be stimulated 8-12 times per day.

40. Complications of Breastfeeding • Improper Latch • Break infants seal and reattempt latch • Check nipple shape and size after seal is broken. • A crease through the nipple indicates an improper latch.

41. Complications of Breastfeeding • Improper Latch (cont.) • Continued improper latching will result in increased pain and damage to nipple. • Purlentant drainage.

42. Complications of Breastfeeding • Improper Latch (cont.) • Need more be said?

43. Complications of Breastfeeding • Plugged ducts and Mastitis • Plugged ducts are caused by incomplete emptying of the breast • Can lead to mastitis • Red, warm and tender to the touch • Can reposition infant so that the chin is aligned with reddened or engorged area.

44. Complications of Breastfeeding • Plugged ducts and Mastitis (cont.) • A mastitis untreated can lead to abess formation.

45. Obstacles with Breastfeeding • Special considerations • Mastectomy or breast reduction • Depending on how much functional breast tissue is remaining breastfeeding should be possible. • Will take more effort and time before the fullest supply that can be will come in • Pumping for additional stimulation is the key!

46. Obstacles with Breastfeeding • Special considerations • Pregnancy and Breastfeeding • Milk supply will naturally decrease with pregnancy due to increased estrogen levels, supplementation may be necessary. • Nipple stimulation can cause pre-term contractions that can lead to pre-term labor. • Our OB says breastfeed the baby until 3 months old or complications with the above occur. • Breastfeeding is not a reliable form of birth control.

47. Obstacles with Breastfeeding • Special considerations • Flat or Inverted nipples • The goal is to get the nipples to become erect so the infant can gain a proper latch. • Finger rolling can relax the nipple enough to become erect. • Using a pump for 2-4 minutes can produce similar results.

48. Obstacles with Breastfeeding • Special considerations • Drying up milk supply • Cold cabbage leaves work well for this purpose. • Best is gradual weaning of infant as infant declares that they no longer need or want the breast.

49. Obstacles with Breastfeeding • Special considerations • Cesarean section • Anesthesia used. • Type of recovery. • Reason for section.

50. References • www.americanbaby.com • www.breastfeeding.com • www.askdrsears.com • www.about.com • www.gotmom.org • Lawerance, R. M., (1999), Breastfeeding; A guide for the medical professional, (5th ed.), Boston : MA.